Marci Lee Nilsen, PhD, MSN, RN, is T32 Postdoctoral Fellow; Heidi Donovan, PhD, RN, is Associate Professor; Leslie Hoffman, PhD, RN, is Professor Emerita; and Susan M. Sereika PhD, is Professor, School of Nursing, University of Pittsburgh, Pennsylvania. Amber Barnato, MD, MPH, MS, is Associate Professor, School of Medicine, University of Pittsburgh, Pennsylvania. Mary Beth Happ, PhD, RN, FAAN, is Distinguished Professor, College of Nursing, The Ohio State University, Columbus.
Nurs Res. 2014 Jan-Feb;63(1):3-13. doi: 10.1097/NNR.0000000000000012.
Valid and reliable instruments are needed to measure communication interaction behaviors between nurses and mechanically ventilated intensive care unit patients who are without oral speech.
The aim of this study was to refine and evaluate preliminary validity and reliability of a Communication Interaction Behavior Instrument (CIBI) adapted for use with mechanically ventilated, nonvocal patients in the intensive care unit.
Raters observed nurse-patient communication interactions using a checklist of nurse and patient behaviors, categorized as positive and negative behaviors. Three-minute video-recorded observations of five mechanically ventilated adults (<60 years old) in the intensive care unit and their nurses were used to establish preliminary interrater reliability and confirm appropriateness of definitions (four observations per dyad, n = 20). On the basis of expert input and reliability results, the behaviors and item definitions on the CIBI were revised. The revised tool was then tested in a larger sample of 38 mechanically ventilated intensive care patients (> 60 years old) and their nurses (four observations per dyad, n = 152) to determine interrater reliability.
For preliminary testing, percent agreement for individual items ranged from 60% to 100% for nurse behaviors and 20% to 100% for patient behaviors across the five pilot cases. On the basis of these results, 11 definitions were modified and four items were dropped. Using the revised 29-item instrument, percent agreement improved for nurse behaviors (73%-100%) and patient behaviors (68%-100%). Kappa coefficients ranged from 0.13 to 1.00, with lower coefficients for patient behaviors.
Preliminary results suggest that the revised CIBI has good face validity and shows good interrater reliability for many of the behaviors, but further refinement is needed. The use of dual raters with adjudication of discrepancies is the recommended method of administration for the revised CIBI.
需要有效的和可靠的工具来测量与不能言语的机械通气重症监护病房患者之间的护士交流互动行为。
本研究的目的是改进和评估适用于重症监护病房机械通气、不能言语患者的沟通互动行为量表（CIBI）的初步有效性和可靠性。
评估者使用护士和患者行为的清单观察护士-患者沟通互动，分为积极行为和消极行为。使用重症监护病房 5 名机械通气成人（<60 岁）和他们的护士的 3 分钟视频记录观察来建立初步的评价者间可靠性，并确认定义的适当性（每对 4 次观察，n = 20）。基于专家的意见和可靠性结果，对 CIBI 的行为和项目定义进行了修订。然后在更大的 38 名机械通气重症监护患者（>60 岁）及其护士样本中（每对 4 次观察，n = 152）测试修订后的工具，以确定评价者间的可靠性。
在初步测试中，在 5 个试点案例中，护士行为的个别项目的百分比一致性在 60%至 100%之间，而患者行为的百分比一致性在 20%至 100%之间。基于这些结果，修改了 11 个定义，并删除了 4 个项目。使用修订后的 29 项工具，护士行为的百分比一致性提高（73%-100%），患者行为的百分比一致性提高（68%-100%）。Kappa 系数范围从 0.13 到 1.00，患者行为的系数较低。
初步结果表明，修订后的 CIBI 具有良好的表面有效性，并且对许多行为具有良好的评价者间可靠性，但需要进一步改进。建议使用双评价者，并对差异进行裁决，作为修订后的 CIBI 的推荐管理方法。
